The proportion of thoracic (heart, lung, heart and lung) transplant recipients living with renal dysfunction 1-year post-transplant was 18.3%.
Chart Explanation: Since 1999 the proportion of individuals designated as having renal dysfunction has decreased only slightly, if at all. However, clearer trends are seen with respect to the lower number of deaths in the first year post-thoracic transplantation and also in the number surviving without a designation of renal dysfunction. The degree of missingness of this indicator also appears to have decreased from 2004 onward.
Individuals who received a solid organ transplant in the United States were followed up annually on the anniversary of the transplant date for an assessment of their health status. These data were recorded in the Scientific Registry of Transplant Recipients (SRTR). All analyses presented are limited to adults aged 20 years or older at the time of their first organ transplant. Diabetes status (type 1 or 2) and hypertension status are as listed at the time of transplant. For all transplant recipients, use of calcineurin inhibitors (CNI) to prevent transplant rejection is presented as many of these medications have been shown to be nephrotoxic1. The recording of data in the SRTR pertaining to CKD/kidney function varied by organ type and is discussed below.
Thoracic transplant (heart, lung and combined heart and lung) recipients did not have a serum creatinine measurement reported but rather a yes/no “renal dysfunction” indicator at follow-up. Information on treatment for ESRD (through dialysis or kidney transplant) is provided for thoracic transplant recipients (all patients treated for ESRD are necessarily indicated to have “renal dysfunction,” but an individual with “renal dysfunction” may or may not have been treated for ESRD). A thoracic transplant patient was defined as having “renal dysfunction” if the patient was reported as such. We have therefore retained the terminology “renal dysfunction” as opposed to “CKD” for this section of the chapter.
1Ojo AO. Renal disease in recipients of nonrenal solid organ transplantation. Semin Nephrol.2007;27(4):498-507.
|Description of Measure||Prevalence of CKD (by eGFR) and Renal Dysfunction|
|Data Source||Scientific Registry of Transplant Recipients|
|Type of Data Source||Registry|
|Health Care System Data||No|
|Regional or National?||National|
|Demographic Group||Solid Organ Transplant Recipients|
|Numerator||Patients in denominator with eGFR<60 (Liver, Kidney) or ‘renal dysfunction’ (Thoracic) at time of follow-up.|
|Denominator||Patients with a valid follow-up code who had a first solid organ transplant between 1999 and 2013 and were at least 20 years old at time of transplant.|
|Definition of diagnosed CKD||Stage 3, eGFR 30-59 ml/min per 1.73 m²
Stage 4, 15-29 ml/min per 1.73 m²
Stage 5, <15 ml/min per 1.73 m²|
|Glomerular filtration rate||Estimated using CKD-EPI formula for calibrated creatinine:|
GFR = 141 × min (Scr /κ, 1)α × max(Scr /κ, 1)-1.209 × 0.993Age × 1.018 [if female] × 1.159 [if black]
|Primary Data Source Indicator||Serum Creatinine measurements/Renal Dysfunction indicator|
|Primary Indicator Method of Measurement||Transplant follow-up|
|Secondary (1) Variable||Type of organ transplant|
|Secondary (1) Indicator Method of Measurement||Registry|
|Secondary (2) Variable||Age|
|Secondary (2) Indicator Method of Measurement||Registry|
|Secondary (3) Variable||Race/ethnicity|
|Secondary (3) Indicator Method of Measurement||Registry|
|Secondary (4) Variable||Gender|
|Secondary (4) Indicator Method of Measurement||Registry|
|Secondary (5) Variable||Diabetes|
|Secondary (5) Indicator Method of Measurement||Registry|
|Secondary (6) Variable||Hypertension|
|Secondary (6) Indicator Method of Measurement||Registry|
|Secondary (7) Variable||Calcineurin Treatment|
|Secondary (7) Indicator Method of Measurement||Registry|
|Secondary (8) Variable||Expanded Criteria Donor Status|
|Secondary (8) Indicator Method of Measurement||Registry|
|Frequency of Measurement (Primary)||Multiple measurements per patient|
|Period Currently Available|
|Additional Data Items of Interest||Trends over time, other stratification variables of interest.|
|Limitations of Indicator||Reporting of data across organ types is not consistent. Reporting of kidney function for thoracic recipients may be subjective. Serum creatinine measurements are only taken once per follow-up, probably resulting in a large standard error.|
|Analytical Considerations||Missing data on serum creatinine measurements may be informative.|
References and Sources:
Ojo AO. Renal disease in recipients of nonrenal solid organ transplantation. Semin Nephrol. 2007;27(4):498-507.
Ojo AO, Held PJ, Port FK, et al. Chronic renal failure after transplantation of a nonrenal organ. N Engl J Med. 2003;349(10):931-40.
Bloom RD, Reese PP. Chronic kidney disease after nonrenal solid-organ transplantation. J Am Soc Nephrol. 2007;18(12):3031-41.
O'Riordan A, Wong V, McCormick PA, Hegarty JE, Watson AJ. Chronic kidney disease post-liver transplantation. Nephrol Dial Transplant. 2006;21(9):2630-6.
Levey AS, Stevens LA, Schmid CH, et al. A New Equation to Estimate Glomerular Filtration Rate. Ann Intern Med. 2009;150(9):604-612.